# DAVIESS COUNTY HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Diversicare of Providence, Charlestown Place at New Albany
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841625662
- **Authorized official:** BRENDA CAMPBELL (DELEGATED OFFICIAL)
- **Authorized official phone:** (859) 255-0075

## Contact information

- **Practice address:** 4915 CHARLESTOWN RD, NEW ALBANY, IN 47150-9426
- **Practice address phone:** (812) 945-5221
- **Practice address fax:** (812) 945-2614
- **Mailing address:** 1050 CHINOE RD STE 350, LEXINGTON, KY 40502-6571
- **Mailing address phone:** (859) 255-0075
- **Mailing address fax:** (859) 281-5150

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 16-001144-1 | IN | — |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2013
- **Last updated:** 01/12/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1841625662 | UNITED HEALTHCARE | — |
| 05 | — | 200256980 | — | IN |